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Background Aim Method Results Conclusion Dipeptidyl peptidase‐4 inhibitors (DPP4i) and sodium‐glucose co‐transporter 2 inhibitors (SGLT2i) are increasingly used as glucose‐lowering therapies in Malaysia.To examine factors associated with the initiation of DPP4i or SGLT2i among people with type 2 diabetes mellitus (T2DM) in Malaysia.A retrospective cohort study was conducted from 1 January 2012–30 December 2020 in two tertiary Malaysian hospitals. Multivariate logistic regression was used to assess the factors associated with DPP4i or SGLT2i initiation. The impact of treatment initiation on glycaemic control, anthropometric and lipid levels at 6 and 12 months were also measured. Ethical approval was granted by the Malaysian National Medical Research Register (Reference no: NMRR‐20‐662‐52570), the Monash University Human Research Ethics Committee (Reference no: 2020‐24900‐45575), the Ministry of Health Malaysia Medical Research and Ethics Committee, and the study conforms with the Declaration of Helsinki.This study included 1628 patients. Patients with co‐existing dyslipidaemia (odds ratio [OR] 1.34, 95% confidence interval [CI] 1.04–1.73), cardiovascular disease (OR 1.43, 95% CI 1.1–1.87), and microalbuminuria (OR 2.47, 95% CI 1.42–4.3), with ≥5‐year history of T2DM (years of T2DM 5–14 OR 1.67, 95% CI1.18–2.38; years of T2DM ≥15 OR 2.07, 95% CI 1.39–3.07), who had a body weight of ≥100 kg (OR 1.75, 95% CI 1.26–2.45), and baseline use of three or more glucose‐lowering medicines (OR 2.92, 95% CI 1.74–4.91) had higher odds of being prescribed with SGLT2i. Patients aged ≥65 years old (OR 0.68, 95% CI 0.50–0.93), presented with a family history of diabetes (OR 0.64, 95% CI 0.47–0.89), an estimated glomerular filtration rate (eGFR) ≥60 mL/min/1.73 m2 (eGFR 60–89 mL/min/1.73 m2 OR 0.60, 95% CI 0.39–0.90; eGFR ≥90 mL/min/1.73 m2 OR 0.55, 95% CI 0.34–0.87), with serum creatinine ≥120 μmol/L (OR 0.31, 95% CI 0.17–0.58), and had baseline usage of sulfonylureas (OR 0.28, 95% CI 0.19–0.4) and insulin (OR 0.5, 95% CI 0.35–0.72) were more likely to receive DPP4i. Glycated haemoglobin of patients receiving these medicines reduced significantly at 6 months (DPP4i: −0.61%, p < 0.001; SGLT2i: −0.66%, p < 0.001) and 12 months (DPP4i: −0.62%, p < 0.001; SGLT2i: −0.74%, p < 0.001).Treatment choice with pharmacotherapy was associated with many clinical risk factors presented by patients. [ABSTRACT FROM AUTHOR]

This study aims to evaluate the cost-effectiveness of various glucose-lowering therapies as add-on to standard care for people with type 2 diabetes (T2D) in Malaysia. A state-transition microsimulation model was developed to compare the clinical and economic outcomes of 4 treatments: standard care, dipeptidyl peptidase-4 inhibitors, sodium-glucose cotransporter-2 inhibitors (SGLT2is), and glucagon-like peptide-1 receptor agonists. Cost-effectiveness was assessed from a healthcare provider's perspective over a lifetime horizon with 3% discount rate in a hypothetical cohort of people with T2D. Data input were informed from literature and local data when available. Outcome measures include costs, quality-adjusted life-years, incremental cost-effectiveness ratios, and net monetary benefits. Univariate and probabilistic sensitivity analyses were performed to assess uncertainties. Over a lifetime horizon, the costs to treat a person with T2D ranged from RM 12 494 to RM 41 250, whereas the QALYs gains ranged from 6.155 to 6.731, depending on the treatment. Based upon a willingness-to-pay threshold of RM 29 080 per QALY, we identified SGLT2i as the most cost-effective glucose-lowering treatment, as add-on to standard care over patient's lifetime, with the net monetary benefit of RM 176 173 and incremental cost-effectiveness ratios of RM 12 279 per QALY gained. The intervention also added 0.577 QALYs and 0.809 LYs compared with standard care. Cost-effectiveness acceptability curve showed that SGLT2i had the highest probability of being cost-effective in Malaysia across varying willingness-to-pay threshold. The results were robust to various sensitivity analyses. SGLT2i was found to be the most cost-effective intervention to mitigate diabetes-related complications. • With the myriad of new glucose-lowering therapies, there is now an unprecedented challenge to choose the most cost-effective treatment as add-on to standard care for people with diabetes. • To our best knowledge, this is the first study to assess the cost-effectiveness of various new second-line pharmacotherapies that are part of a national medicine reimbursement program in a middle-income country. Our economic model found that sodium-glucose cotransporter-2 inhibitors as add-on to standard care provided the highest net monetary benefit among all the other glucose-lowering therapies included. • Our findings highlight the cost-effectiveness of incorporating new glucose-lowering therapy, sodium-glucose cotransporter-2 inhibitor in diabetes management. The findings would be useful to inform decision making for clinicians, policy makers, and the public in tackling this chronic disease. [ABSTRACT FROM AUTHOR]

Background Diabetes is one of the leading causes of chronic kidney disease (CKD) and end-stage renal disease. This study aims to develop and validate different risk predictive models for incident CKD and CKD progression in people with type 2 diabetes (T2D). Methods We reviewed a cohort of people with T2D seeking care from two tertiary hospitals in the metropolitan cities of the state of Selangor and Negeri Sembilan from January 2012 to May 2021. To identify the 3-year predictor of developing CKD (primary outcome) and CKD progression (secondary outcome), the dataset was randomly split into a training and test set. A Cox proportional hazards (CoxPH) model was developed to identify predictors of developing CKD. The resultant CoxPH model was compared with other machine learning models on their performance using C-statistic. Results The cohorts included 1992 participants, of which 295 had developed CKD and 442 reported worsening of kidney function. Equation for the 3-year risk of developing CKD included gender, haemoglobin A1c, triglyceride and serum creatinine levels, estimated glomerular filtration rate, history of cardiovascular disease and diabetes duration. For risk of CKD progression, the model included systolic blood pressure, retinopathy and proteinuria. The CoxPH model was better at prediction compared with other machine learning models examined for incident CKD (C-statistic: training 0.826; test 0.874) and CKD progression (C-statistic: training 0.611; test 0.655). The risk calculator can be found at https://rs59.shinyapps.io/071221/. Conclusions The Cox regression model was the best performing model to predict people with T2D who will develop a 3-year risk of incident CKD and CKD progression in a Malaysian cohort. [ABSTRACT FROM AUTHOR]